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§ Mr. James Cran (Beverley)
I am extremely grateful for the opportunity to raise two problems that affect the East Yorkshire health authority. I know that my hon. Friend the Parliamentary Under-Secretary of State for Health and Social Security is well aware of them, as I am pleased to say that she visited the authority a week or so ago. The first problem does not necessarily particularly affect any other district health authority. However, I am convinced —unless my hon. Friend can tell me otherwise—that the second problem will certainly affect other district health authorities, and that is why I am raising it now.
The East Yorkshire health authority has not always been successful. It would be silly of me to claim that it has. However, I have no doubt that it is successful now. It delivers services to my constituents and to people in neighbouring constituencies in a way that would draw a certain amount of acclamation from my hon. Friend and her Department. We would be entitled to believe— and I thought that I was entitled to believe—that a successful health authority, like the divine Greta Garbo, has a right to be left alone. I am sorry to report that that is not the case. The East Yorkshire health authority is not being left alone.
The first problem that I want to address to the House involves successive proposals to reorganise health services on the north bank of the Humber. If an attempt at amalgamating East Yorkshire health authority with the Hull health authority had occurred once, I might be entitled to make a small protest. If it had happened twice, I might be entitled to make a rather larger protest. In fact, as my hon. Friend is aware, attempts at amalgamation have not occurred once, twice, or thrice. As far as I can understand from the record, five attempts have been made. Indeed, there might even have been six attempts, depending on one's definition of an attempt at amalgamation. The last attempt occurred this year. The problem is therefore not old. It is still a current issue, or seems to be.
My hon. Friend will be aware of my views on this matter, as they are fairly well known. I lobbied against an amalgamation because I did not see evidence to suggest that the delivery of resources and care for patients would be any greater as a result of amalgamation. A more important consideration, and one that I have applied to local authorities, is that the closer we can get the provision and delivery of services to the consumer, the better.
With that background, my hon. Friend would have been as delighted as I was to receive a copy of the letter that I received on 5 February from the chairman of the Yorkshire regional health authority, who said:Dear James,Whilst we decided not to proceed with the merger"—now, that was wonderful—we did see the need for increased co-operation and collaboration in a number of areas. For this reason we shall be undertaking a full option appraisal on the optimum long term pattern of general hospital services on the North Bank of the Humber for the total population.I want to reassure my hon. Friend that I am not prepared to argue with that, as that is perfectly legitimate. On the one hand there is an assurance that there will he no merger, and on the other the letter states that an examination must be made of the two health authorities to optimise the services.
1317 However, I received another piece of paper with that letter, which was a recommendation dated 28 January 1988 from the Yorkshire regional health authority. That did not seem to be consistent with the chairman's comments. The recommendation wasthat no action be taken at the present time in respect of possible unification of East Yorkshire and Hull Districts.I am bound to draw the attention of the House, my hon. Friend and you, Mr. Deputy Speaker, to the fact that after six attempts at amalgamation we are entitled to know what "at the present time" means. I am entitled to construe that perhaps it means that someone else will have yet another go at amalgamation. We would be forgiven for thinking that perhaps that would happen not in five or 10 years' time, but in five or 10 months' time. There is therefore a certain lack of consistency in the signals coming from the Yorkshire regional health authority.
With regard to that inconsistency, I have the minutes of a meeting held on 21 March between the regional health authority and the East Yorkshire district health authority and Hull health authority. The minutes state that the chairman of the Hull health authorityindicated that as far as Hull was concerned, the districting issue was finished.The regional health authority chairman, Mr. Brian Askew, said that it wastime that the districting issue was forgotten.
§ Mr. Cran
If ever I had a confused set of signals, it must be those that I have described to my hon. Friend. Although I may have been entitled to a certain amount of levity on this subject, the serious point is that the regional health authority and my hon. Friend have responsibility to clear up the issue. In saying that, I am not ruling out the fact that we will not look at the whole of Yorkshire or any other part of the country to find a better system of organising the Health Service in future. We may do that, but I am wholly against this piecemeal organisational tinkering which leaves my constituents not knowing which health authority will be in place at any given time.
That also means that the managers within the health authority do not have much confidence in their jobs and how to do them, because they do not know who they are working for. If the authority was a business, the company involved would have a continual takeover threat hanging over it. With such a sword of Damocles hanging over it, how can we possibly expect managers in the East Yorkshire health authority to deal confidently with their jobs and manage the health authority properly?
I humbly submit that under the laughable circumstances that I have outlined, they cannot be expected to do their jobs properly. The managers are doing their best, and they are doing their jobs well, but I would not be surprised if some of them were beginning to wonder what was happening. I therefore want a little clarification of the Government's view of the lack of direction from the regional health authority.
Problems seem to come in multiples for East Yorkshire health authority. The second one relates to the fact that it has with a vengeance got on and done its job. As my hon. Friend knows, it started with 12 inefficient and poorly 1318 utilised hospitals, which resulted in a waste of resources. Having established that that was the case, the chairman, the general manager and the board set about considering how to use their resources better and, with everyone's cooperation, reduced 12 inefficient hospitals to seven more efficient hospitals, which is exactly what my hon. Friend, the Government and the community want.
That move freed a large amount of revenue which the authority believed, perhaps naively, it could use to improve its resources. Its property sales during the past three years having been worth £2.5 million, which is a considerable sum, it intended to use the money to transform Castle Hill hospital in Cottingham into a district general hospital, which was an eminently sensible decision. That has only partially been implemented.
The nub of the problem is that that which you have is not necessarily yours, Mr. Deputy Speaker, because, at a regional health authority meeting, decisions were made on what is called resource allocation, and the minutes state:It is therefore recommended that the planned reduction of allocation to East Yorkshire be commenced in 1988–89 by a reduction of £1 million.All this is a week or so before the new financial year starts, so the problems have been compounded. The minutes continue:This then creates the sum"—it certainly does—of £1 million for redistribution within the Region and the RHA is recommended to agree to the following proposals.The proposals are that East Yorkshire should get back £250,000 of its own money for improvements to be agreed in cardi-thoracic services. It is also fortunate enough to get back a further £250,000 to be held for mental health bridging purposes as proposed by the authority. Details of the programmes are to be agreed by the regional health authority.
That is all right thus far, but the third recommendation is that £500,000 should go to Hull health authority in recognition of its overall RAWP position. There it is, Mr. Deputy Speaker. A district health authority creates £2.5 million by getting rid of unused and inefficient resources and it then thinks, "How shall we use those resources for the benefit of our patients?" It then decides to create a district general hospital and embarks upon the project but, all of a sudden, part of the resources are taken away from it and given to someone else. If ever there was an example of banditry at work, I am entitled to say that this is it. East Yorkshire health authority may be forgiven for thinking that it had acted in accordance with the Government's policies. I believe that it has, and if it has not no doubt my hon. Friend will tell me, but it certainly seems to have struck the wrong chord with the Yorkshire regional health authority.
As I am sure my hon. Friend will be aware, at least two other district health authorities in Yorkshire which are also significantly above their RAWP allocations have not had a reallocation of resources in the bandit-like manner that I have just outlined. I suspect that there is a pretty good reason for that: they did not have the foresight of East Yorkshire health authority to divest themselves of resources that they did not want and use the money to improve patient services, which is what they should have done.
The message is that district health authorities must beware of selling assets which they do not require. Any district health authority that decides to sell its unwanted assets should beware, because there may be a robber 1319 somewhere — in the form of another district health authority—ready to nab that money if it has the ear of its regional health authority. It follows that I do not understand the logic of the decision made by Yorkshire health authority. That is not to say that I do not recognise the problems of Hull district health authority. It would be silly of me to say that. The authority has resource problems, and it must cater for patients who originate from the area of the East Yorkshire health authority. But that problem will diminish by allowing East Yorkshire to keep its cash and build its district general hospital. Then it will have the facilities to cater for its own patients. That, not the reallocation of resources, is how to reduce the problem.
It would idle of me not to suggest to the House and to everyone who is fair-minded — I have no reason to believe that my hon. Friend is other than fair-minded— that it will be exceedingly difficult to motivate not only East Yorkshire but any other health authority to divest itself of assets that it does not need when it cannot be sure of keeping those resources. It does not make good horse sense, and I repeat that other district health authorities should beware of what happened in East Yorkshire.
I am also entitled to question the figure of 6.1 per cent. above RAWP target for East Yorkshire for 1988–89. All the figures available to me from the health authority show that there has been a rapid increase of between 20 and 30 per cent. in the number of patients being treated. The regional health authority is using historical figures, and the clear message is that the authority should use more up-to-date figures. It is ludicrous to reduce the allocation while activities are increasing.
After that endless parody of a case that I would not have believed unless I had seen it in action, I wait with bated breath to hear my hon. Friend's comments.
§ The Parliamentary Under-Secretary of State for Health and Social Security (Mrs. Edwina Currie)
I congratulate my hon. Friend the Member for Beverley (Mr. Cran) on winning a place in the ballot. In the short time that he has been in the House he has shown a keen interest in health and welfare matters. I do not know whether he realises it, but so far he has written me 35 letters and tabled 10 questions, and now he has taken up the cause in debate. He is one of the most active of the new intake, and I commend to his constituents, whom he represents so well, his persistent but courteous approach to Ministers, which I am sure will bear fruit.
East Yorkshire health authority covers most of the area known by the old and much-missed name of the East Riding of Yorkshire. It includes the hinterland of Hull, but not the city itself, which has its own health authority. We expect the East Yorkshire and Hull health authorities to work closely together, with Scarborough to the north and York to the west, to plan and provide services for the people of the entire neighbourhood. I am sure that my hon. Friend would agree with that, although I understand his misgivings about formal mergers. I hope that he can support the co-operation that I have just mentioned, since we hope to provide a high standard of cost-effective service to the people of Yorkshire. I note that he is nodding in assent.
I take up with my hon. Friend the word "districting", which I believe he used when quoting from a health authority document. I hope that our friends in Yorkshire, 1320 whatever else they may be doing so brilliantly, will be careful about the surgery that they are performing on the English language. I think that they meant the discussion of mergers or boundary changes.
As my hon. Friend will know, the funding of the NHS has increased substantially. This year we will be spending £21 billion on the NHS, and next year we will be spending £22 billion. For the hospital and community health services in England, for which I have responsibility, funding has increased from £8.1 billion in 1982–83 to £11.5 billion this year. This is an increase of 38 per cent. in cash and 11 per cent. in real terms over a five-year period. We might use that to reflect on the 2 per cent. per annum growth that some critics will call for. We have already been getting that level of growth.
Funding for Yorkshire regional health authority has risen from £583 million in 1982–83 to £818 million this year. This is an increase of 40 per cent. in cash and 12 per cent. in real terms, which is slightly more than the national average.
This year East Yorkshire health authority will be spending £40 million. It has also received £80,000 under the waiting list initiative for two of its projects, and it has added to that from its own resources, as my hon. Friend described. Its costs improvement programme amounts to some £820,000, which is 2.1 per cent. of its budget. According to my figures, it also has available £1.25 million this year from land sales.
Those are substantial figures and they reflect considerable credit on the health authority. Indeed, they would reflect credit on health authorities twice its size. I hope that some of the bigger health authorities, including those elsewhere in Yorkshire, to which my hon. Friend referred, whose performances are, shall we say, more sluggish, will take due note of what they have been up to in East Yorkshire health authority. If they are not taking due note, we are. I assure my hon. Friend of that. I take seriously his point about incentives.
Many health authorities have developed a good record of improvements in service—quality, quantity and cost-effectiveness — under the guidance of the Government. East Yorkshire has a much better record than many, particularly in the vigorous examination of patterns of work, which have often been long established, the release through planned change of additional resources —through its own efforts — and the intelligent reapplication of those funds to improve local health care. In 1986–87 East Yorkshire achieved cost improvements of £1.36 million, which was just under 3.5 per cent. of the budget. In 1987–88 it will, as I have mentioned, achieve improvements of £818,000, which is 2.1 per cent. of its budget, and next year it hopes to achieve £865,000, or 2.2 per cent. It has achieved that by careful scrutiny of, for example, domestic support services, portering, transport and energy conservation measures, which released £116,000 in 1986–87 and will release a further £55,000 in the year to come.
As my hon. Friend said, I saw all that myself last week when I visited Castle Hill hospital at Cottingham to open the new cardio-thoracic wards. The new wards form part of the major upgrading of the cardio-thoracic facilities that serve the four Humberside health authorities — East Yorkshire, Hull, Grimsby and Scunthorpe—and part of north Yorkshire. It is a magnificent development and demonstrates the commitment of the Government, the 1321 Yorkshire regional health authority and the district health authorities to improving the services for patients suffering from coronary heart disease.
I greatly enjoyed my visit. The sun shone and everybody was dancing around like lambs with two tails. They were so pleased with the new facilities. I would be grateful if my hon. Friend would pass on my appreciation to all his constituents and to Mr. Hooper, the chairman of the East Yorkshire health authority, Mr. Nichols, his district general manager, Mr. Nair and Mr. Moghissi, the consultant surgeons and all the staff and patients for their kindness and hospitality during my visit.
The food that I had was some of the best I have ever tasted. Indeed, I asked for the recipes. It was the first health authority lunch that I have attended in recent times where non-alcoholic drinks were served throughout, and I suspect that the conversation was all the better for it.
The darker side of British life, particularly in Yorkshire, was also brought home to me a little later when, in one of the wards, I met a young girl not yet 30 who was being treated for lung disease. She had been a cigarette smoker since childhood. I was moved that day, as I always am, at meeting so many people suffering from what we now know to be preventable diseases. The Yorkshire regional health authority and the local district health authorities in Yorkshire are taking those matters seriously and have increased their health promotion budget in ways that we hope will bear fruit in years to come.
The new cardio-thoracic wards are not the only capital developments at Castle Hill and in the East Yorkshire health authority. For example, in January work was started at Castle Hill on a major project to build a new surgical unit that will comprise four operating theatres, four wards and a day ward. I could see that work proceeding apace during my visit. In addition, on 5 March the new Bridlington community hospital, which is managed by the East Yorkshire health authority and which was built at a cost of about £16 million, took its first patients. I well remember my hon. Friend's question to me about the new hospital on 27 October, when he reminded me that it was completed ahead of time. That hospital will provide 200 beds for acute elderly and maternity patients, a 60-place day hospital, an operating theatre suite, outpatient departments and support facilities. It is a splendid development and it will clearly make a major contribution to improving health services in East Yorkshire.
I refer now to my hon. Friend's point about the £1 million reduction in the allocation. As he will know, the distribution of resources to district health authorities is a matter for the regional health authority concerned—in this case, the Yorkshire region. Clearly, regional health authorities must take into account the balance of resources between districts and ensure that there is a fair and equitable distribution. What we do as Ministers is allocate money to regional health authorities. They then send it out. The RAWP formula is intended only to assist us in sending money out to regional health authorities. It is not intended to be any more than the vaguest guide for allocation between districts. Indeed, as my hon. Friend knows, we are currently looking at the RAWP formula. There may be some amendments which, perhaps, will take into account changing patterns of population growth in many parts of the country.
1322 The money does not, however, belong to the regional health authority. It does not belong to the district health authority — East Yorkshire or otherwise. It does not belong to any of us. It belongs to the taxpayer. Eventually, we have to account to the taxpayer — him or, more likely these days, her—for every penny that we have. There is total homogeneity about the money. It does not acquire a different colour the moment it is allocated to East Yorkshire. I am afraid that it is exactly the same money, and it is raised and accounted for in exactly the same way.
I understand that East Yorkshire has had its revenue allocation, which it controls, reduced by £1 million for 1988–89. That is because, since 1985–86, East Yorkshire had been treating fewer of its own local patients than had been expected and planned for. This has created additional pressures on the neighbouring authority in Hull. In particular, although East Yorkshire health authority is treating cardiac patients from neighbouring health authorities, large numbers of psychiatric patients are crossing the border into Hull, where resources are being stretched to meet their care.
The pattern of revenue funding that we have had so far has enabled East Yorkshire to transfer considerable sums of money every year from revenue to capital, which does not lead one to feel that the revenue side of its budget has been under enormous strain. I am advised that the adjustment will not adversely affect patient services, although I can well understand that the management of East Yorkshire health authority, which naturally had all sorts of plans for spending that money, could feel somewhat troubled.
We should look at it this way: the NHS money has been redistributed to the benefit of NHS patients. As my hon. Friend said, of the £1 million, £250,000 will be used to improve the super district cardio-thoracic services at Castle Hill hospital. This means that services are available for patients from more than just one district. Thus, that handing back of £250,000 will reflect the movement of patients into East Yorkshire. A further £250,000 will be earmarked by the region as a bridging fund for mental health services in East Yorkshire.
If my hon. Friend was able to hear any of the debate that immediately preceded this one, he will know that we have difficulties in creating the kind of community care services that we all want to see, so that people do not have to travel a long way from home for their care and, particularly, in the case of the long-term chronic sick and mental illness, they can expect to be cared for closer to home. The remaining £500,000 will be allocated to Hull, in part to reflect the cross-boundary flows that I have already mentioned.
This is not a cut, and it is not banditry either. I assure my hon. Friend that spending in his constituency and in the vicinity is still tending to go up, not down. Neither the Chancellor nor the taxpayer will see that £1 million again. I suspect that it will be joined by many more millions of pounds in years to come, as I have already said. People from the north bank of the Humber, including my hon. Friend's constituents, will continue to benefit from this money. It has been earmarked for specific services within East Yorkshire, rather than giving the DHA an entirely free hand with spending, and it will provide services from which East Yorkshire's residents will benefit. The continuing capital development at Castle Hill should not be affected.
1323 As my hon. Friend said, a full-option appraisal will be undertaken on the optimal long-term pattern of general hospital services on the north bank of the Humber for the total population. Further, the two district health authorities have been asked to report within six months on the opportunities for the management of services for mental illness and mentally handicapped people. Perhaps the report will be made by one authority on behalf of both. The revenue allocation in respect of other services will be reviewed. It will have regard to the most recent information on the cross-boundary flow and it will be monitored thereafter, which should pick up some of the points that my hon. Friend mentioned.
We look forward to further co-operation in the health care of local people, which will benefit everyone, including my hon. Friend's constituents.